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Sterile Processing of Surgical Robotics

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LEARNING OBJECTIVES:
1. Discuss advantages of utilizing a surgical robot.

Instrument 2. Identify three basic components of a surgical robotic system.


3. Describe functional components of robotic instruments.
Continuing 4. Compare processing of traditional laparoscopes with robotic scopes.

Education 5. Relate importance of proper packaging and labeling techniques.

(ICE)
SELF-STUDY Robotic surgery is not a dream of the future for today's hospitals; it is a
reality. Surgical teams, including the surgeon, assistant, scrub person and
circulating nurse are provided extensive specialty training before using the
robotic system. Because the patient and surgical team require the support of
dedicated sterile processing technicians to assure positive patient outcomes,
they too must be provided specialty training. This training must take place
prior to scheduling the first robotic procedure. While the sterile processing
team may be the last to receive the training required to properly process
robotic devices, they are vital to the overall success of the program.

Carla McDermott, RN, CRCST, ACE


Education Specialist, Training to process robotic devices should robotic systems, as well as each specific
Morton Plant Mease Healthcare include a brief introduction of the robotic type of surgical procedure to be
Dunedin, FL concepts. Information outlining attempted. Several additional systems are
mailbox@iahcsmm.org
advantages and limitations that relate to currently pending FDA approval.
procedures performed using this
Surgical robots are not designed to
Instrument Continuing Education lessons technique will be helpful. Explicit
provide members with ongoing education replace the surgeon, or any team
instructions are required regarding specific
in the complex and ever-changing area member; they function as an extension of
handling, packaging and sterilization
of surgical instrument care and the team members. Advantages of
techniques of the devices to be utilized.
handling. These lessons are designed utilizing surgical robots include the ability
for CIS technicians, but can be of value The manufacturer will be your resource
to work through even smaller port
to any CRCST technician who works for education materials. Insisting on
incisions. Smaller ports mean less tissue
with surgical instrumentation. written policies, procedures and
damage, and less tissue damage means
The Instrument Continuing Education
competency evaluations will help to
less healing time is required for the
(ICE) lessons are easy to use. Just read ensure the facilities 1.5 million-dollar
patient to return to normal activities.
and study the article, take the quiz at the investment is handled and processed
end of the article (see page 18), and Less physical trauma also means less pain
appropriately.
log on to www.iahcsmm.org to grade for the patient and less potential for
and print your quiz results (click the Our collective imaginations have 'grown' blood loss requiring blood replacement.
Instrument CE banner or navigate to incredibly versatile robots over the years, Reduced hospitalization time reduces the
www.iahcsmm.org/ICE_home.htm). resulting in 'generations' of the fictitious potential for a hospital acquired infection.
Successfully completed ICE lessons can
help you gain recertification points.
man-made creations. Real life is Using a robotic camera provides a
following the lead. Two types of surgical superior view of the surgical site.
robots are currently available for use in Traditional laparoscopes provide the
the United States. The Food and Drug surgical team with a two dimensional
Administration (FDA) must approve the picture. Robotic scopes provide the
IAHCSMM
Instrument Continuing Education (ICE) Self-Study

surgeon with a three dimensional view. accomplish each task. rinses clear. All instruments should be
Other team members continue to see two protected from mechanical shock (being
The instrument list will sound familiar to
dimensional views on monitor screens. dropped, striking other instruments, etc.)
the Sterile Processing and Certified
The robots do not get tired or hungry and and stress (bending, placed under heavier
Instrument Specialist. There will be one
have to be relieved during a procedure. instruments, etc.). As with other surgical
or more flexible endoscopes, light guide
Their movements are consistent in speed, instruments, avoid use of hydrogen
cable, light guide cable adaptors, camera
force, and form. One of the more simple peroxide, bleach, or alkaline-based
arm sterile adaptor, camera sterile
models consists of a single 'arm' that cleaning agents.
adaptor, instrument sterile adaptor,
mounts to the operating table. It may be
graspers, scissors, large and small needle Packaging and sterilization of robotic
controlled by the surgeon utilizing a foot
drivers, blades, instrument arm cannula components requires a keen adherence to
pedal or voice activation with the surgeon
(sheath), cannula adaptors, obturators processing guidelines. Improper
remaining in the sterile field at the
and reducers. Education for processing packaging or labeling of package
patient's side. The single arm typically
these instrument components is vital. contents will contribute to utilization of
manipulates a traditional laparoscopic
There is one critical difference from incompatible sterilization processes.
camera or holds a retracting instrument.
common laparoscopic instrumentation; Severe instrument damage can result.
The more complex model currently
both the instruments and scopes have Labeling is also key to avoiding
available may utilize up to five 'arms'
electronic and microprocessors built into misplacement of individually packaged
attached to a mobile base. The surgeon
them. The adaptors are the computer components. And as noted earlier in this
scrubbed and at the sterile field, makes
links that connect the control console to lesson, the names are similar to other
incisions for placement of the ports.
the operating end of the instrument. more common laparoscopic instruments.
Next, the base station that has been
Robotic instrumentation is even more A great deal of stress is avoided when the
covered with sterile drapes is moved into
fragile than general laparoscopic proper instrumentation, in proper
very close proximity to the patient.
instruments. Currently, not all the working order is available to the surgical
Instrument arms are placed into the ports
components can be cleaned or sterilized team as requested. Attention to detail is
then 'docked' to the base station arms.
by the same method. As with general crucial in selecting the appropriate
As this is being completed, the surgeon
laparoscopes, current robotic endoscopes packaging system and applying complete
drops out of the sterile field and takes his
can not be cleaned in an ultrasonic bath. and correct labeling of the devices.
place at the control console. Both the
The remaining components vary in the Limited availability of these exquisitely
base and control console are quite large,
recommendation for ultrasonic cleaning. expensive instruments means each piece
each being larger than a refrigerator.
All of the current robotic endoscopes may can impact the success of every robotic
These components communicate by
be sterilized with gas plasma or ethylene surgical procedure. The Certified
computer link-up so distance is irrelevant.
oxide. All components (other than the Instrument Specialist will play a vital role
They can be located across the room or
actual endoscope) are to be steam in providing sterile processing support to
across the state from each other.
sterilized, and not presently approved for their facility's robotic program.
Microphones and speakers allow the
processing by any other sterilization
surgeon and the surgical team members
method. Flash sterilization is specifically References:
who remain in the sterile surgical field to
NOT recommended for any of the
communicate verbally. Working from the Lind, Natalie; Instrumentation Resource
components. All these variances add to
control console, the surgeon can perform Course: Identification, Handling and
the importance of thorough training and
a variety of procedures. Currently the Processing of Surgical Instruments.
written guidelines.
FDA has approved robotics for use in Intuitive Surgical, 2006; Instrument
open heart, urology, gynecology and Instructions for proper cleaning begin Cleaning and Sterilization Instruction
neurology procedures. Voice, hand and with the surgical team who should not Manual
foot controls are used simultaneously to allow debris to dry in or on the
manipulate the robotic instruments. Pott PP, Scharf H-P, Schwarz MLR, Today's
instruments. Soaking them in water or
Movements generated from the control State of the Art of surgical Robotics,
enzymatic cleanser between operative use
console can mimic every movement of Journal of Computer Aided Surgery, 10,2
and instrument processing is strongly
the human hand. Even better, the device 101-132, 2005
recommended by the manufacturer.
can compensate for fine muscle motor Flush ports and intricate movable parts Prosurgics - Precision Robotics for
tremors the surgeon may experience. It is require a combination of manual and Surgeons; http://www.prosurgics.com/
truly amazing to watch just how delicate ultrasonic cleaning. This process may
and precise the movements are to need to be repeated until the instrument
IAHCSMM
Instrument Continuing Education (ICE)
Powered Surgical Instruments
Questions (circle correct answer):

1. Surgical robotic instruments require additional education for the 9. Surgical procedures that include the use of a robotic system
Sterile Processing team who will be responsible for reprocessing must first be approved by the FDA.
these items. True
True False
False
10. Poor labeling guidelines could result in misplacement of packaged
2. Robotic programs are relatively inexpensive to initiate in the robotic devices.
hospital. True
True False
False
11. A surgical robotic system consists of a base station, docking
3. The primary goal of surgical robotics is to reduce the number of station and arms.
people required in the operating room. True
True False
False
12. Cleaning instructions are very similar to more common laparoscopic
4. The Food and Drug Administration regulates use of surgical instrumentation.
robotic devices. True
True False
False
13. Robotic endoscopes can be sterilized using peracetic acid.
5. One advantage of using surgical robotics is reduced tissue damage True
and pain. False
True
False 14. Computer link ups allow the control console to be positioned
any distance from the patient.
6. Larger ports are required for use of robotic instrumentation. True
True False
False
15. Certified Instrument Specialists are great additions to a facilities
7. The control console provides the surgeon with a superior three robotic program.
dimensional view of the operative site. True
True False
False
8. Robotic devices are sturdy by design and require minimal Sponsored by:
protection
during processing.
True
False

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Lesson 200
May 2012
Lesson expires May 2015 Name

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